1
Die Geschichte der Gerson Therapie
2
http://www.commonweal.org/choices-in-healing/chapter-
fourteen/
Chapter Fourteen
PART FOUR
Mainstream Nutritional Science and the Unconventional Nutritional
Cancer Therapies
Chapter Fourteen
The Gerson Diet–A Radical Anticancer Therapy
“I see in Max Gerson one of the most eminent geniuses in medical
history.”
-Albert Schweitzer
Until the advent of the macrobiotic diet, the Gerson therapy was,
for many years, the best-known nutritional therapy for cancer in
the United States. Today, thousands of cancer patients still
practice the Gerson diet and diets based on Gerson’s regimen.
The Gerson Institute in Bonita, California, directed by Charlotte
Gerson, Max Gerson’s daughter, and the Gerson Clinic in
Tijuana, Mexico, continue his work. Derived from a combination
of scientific research and the European folk medical tradition by
German physician Max B. Gerson, the therapy requires a patient
to eat a raw vegetarian diet for a prolonged period. Cooked foods
and some animal products may be added later. A patient drinks
specific freshly prepared vegetable and fruit juices every hour,
takes four types of enemas, including coffee enemas, and also
consumes two to three glasses of fresh calf’s liver juice each day.1
The Gerson regimen as currently offered in Mexico is a radical
anticancer therapy in that it involves a tremendous level of
personal commitment. When fully undertaken, it requires a full-
time effort by a reasonably mobile and energetic person who does
not have to work and who has access to the requisite fresh
organic produce year-round. It works best when undertaken
jointly by a cancer patient and a spouse or friend, and even then
3
it is close to a full-time project for both people. The psychological
consequences of making and sustaining such a full-time
commitment to physical recovery are potentially a significant
element in recoveries associated with the Gerson program.
Patricia Spain Ward, Ph.D., a medical historian at the University
of Illinois at Chicago, has outlined the history of the Gerson
therapy for the Office of Technology Assessment:2
It is one of the least edifying facts of recent American medical
history that the profession’s leadership so long rejected as
quackish the idea that nutrition affects health. Ignoring both the
empirical dietary wisdom that pervaded western medicine from
the pre-Christian Hippocratic era until the late nineteenth
century and a persuasive body of modern research in nutritional
biochemistry, the politically-minded spokesmen of organized
medicine in the U.S. remained long committed to surgery and
radiation as the sole acceptable treatments of cancer. .ê.ê.
The historical record shows that progress lagged especially in
cancer immunotherapy–including nutrition and hyperthermia–
because power over professional affiliation and publication (and
hence over practice and research) rested with men who were
neither scholars nor practitioners nor researchers themselves,
and who were often unequipped to grasp the rapidly evolving
complexities of the sciences underlying mid-twentieth-century
medicine.
Nowhere is this maladaptation of professional structure to
medicine’s changing scientific content more tragically illustrated
than in the American experience of Max B. Gerson (1881-1959),
founder of the best-known nutritional treatment for cancer of the
pre-macrobiotic era. A scholar’s scholar and a superlative
observer of clinical phenomena, Gerson was a product of the
German medical education which Americans in the late 19th and
early 20th centuries considered so superior to our own that all
who could afford it went to Germany to perfect their training.3
Gerson’s Biography
4
Gerson graduated from the University of Freiburg in 1909, having
studied with leading specialists in internal medicine, physiological
chemistry, and neurology. By 1919 he had set up a practice and
had devised an effective dietary treatment for migraine, from
which he himself suffered. “In 1920,” Ward reports, “while
treating migraine patients by this salt-free diet, he discovered that
it was also effective in lupus vulgaris (tuberculosis of the skin,
then considered incurable) and, later, in arthritis as well.”4
His success with tuberculosis of the skin brought Gerson renown
and an opportunity to test the diet with larger numbers of lupus
patients at a special Bavarian government-sponsored clinic. The
diet was then extended to cases of pulmonary tuberculosis as
well. He served as a member of the State Board of Health in
Prussia, and also as a consultant to the Prussian Ministry of
Health on how to restore depleted soils for agriculture. Ward says:
“When he learned that modern farming methods often rob plants
of their natural mineral and vitamin riches, while increasing their
sodium content, he began to think of the earth’s well-being as our
own. Eventually, he began to refer to the soil, which nourishes
the food we eat, as our “external metabolism.”5
Gerson first used his diet for cancer in 1928, when a woman with
bile duct cancer that had metastasized to the liver insisted he put
her on the diet, despite his reluctance to do so. The patient
introduced him to a special soup which, according to German folk
medical lore, Hippocrates had used for cancer, and which Gerson
later adopted for his own therapy. “Having taken up this
challenge against his will, with no hope of success,” reports Ward,
“Gerson was astounded when his patient seemed fully recovered
within six months. In quick succession he had the same good
results with two patients with inoperable stomach cancer.”6
After the rise of Hitler, Gerson moved to Vienna where he reported
the diet failed with six cancer patients, in his view as a result of
poor dietary supervision at the institution where he worked. He
then moved to Paris, where he reported the diet produced good
results in three of seven cases. He emigrated to the United States
5
in 1938 and in 1939 passed the state medical boards in New
York, where he continued to perfect his diet.7 Ward continues:
Despite the fact that he had no in-patient facility until 1946,
when he opened a clinic in Nanuet, New York, Gerson managed,
through his thriving Park Avenue practice and an affiliation at
Gotham Hospital, to amass enough data to publish a preliminary
report in 1945. He presented his rather remarkable cases
modestly, concluding that he did not yet have enough evidence to
sayêwhether diet could either influence the origin of the cancer or
alter the course of an established tumor. He claimed only that the
diet, which he described in considerable detail, could favorably
affect the patient’s general condition, staving off the
consequences of malignancy and making further treatment
possible.8
The AMA did not openly attack Gerson until November, 1946, a
few months after he testified in support of a Senate bill to
appropriate $100 million to bring together the world’s
outstanding cancer experts in order to coordinate a search for the
prevention and cure of cancer.9
In many respects, the Senate hearing was hostile to conventional
approaches to cancer therapy, and it would have been naive for
anyone not to anticipate a possible reaction from the American
Medical Association. Gerson presented patients of his who had
failed on conventional therapies; he received a strong testimony of
support from the medical director of Gotham Hospital, who also
reported the results of a study which found that patients who
received no treatment for cancer lived longer than conventionally
treated patients; and another witness called Gerson’s successes
“miracles” and, as Ward reports, urged the Senators to secure
their future cancer commission against control by any existing
medical organization.10
Historically, this was a period in which the AMA had recently
established its hegemony over American medicine. It was headed
by Morris Fishbein, a pugnacious physician who was to make
6
himself infamous in the eyes of many advocates of
unconventional cancer therapies for his attacks on Gerson,
Hoxsey, and other pioneers of unconventional therapies. It is no
surprise to me that Fishbein, faced with congressional hearings
inimical to conventional cancer treatment and AMA hegemony,
went on the attack. The details of the process by which the AMA
destroyed Gerson’s professional reputation have been described
by Ward and others. Gerson lost his hospital affiliation and was
denied malpractice insurance:
According to a 1981 publication of the Gerson Institute, headed
by his daughter, Charlotte Gerson, a manuscript for a book he
was writing about his therapy disappeared from his files in 1956.
At the age of 75, isolated from medical colleagues and unable to
find assistants, Gerson undertook the work of rewriting the entire
manuscript in order to show “that there is an effective treatment
of cancer, even in advanced cases.” It was published in 1958 as A
Cancer Therapy: Results of Fifty Cases. Gerson died of
pneumonia the following year.11
Interpreting the AMA Attack on Gerson
In evaluating this history, I come down somewhere between the
interpretation offered by advocates of the Gerson therapy and
that offered by the mainstream critics of Gerson. Many medical
historians would agree with Ward that the rejection of nutritional
approaches to health in general, and cancer in particular, is
among the “least edifying facts” of recent American history. As
time passes and scientific evidence supportive of the Gerson and
other nutritional approaches to cancer gradually grows,
Fishbein’s and the AMA’s attack on Gerson appears in a less and
less favorable light.
On the other hand, a close reading of Ward’s recounting of the
history of what happened to Gerson shows that the AMA attack
on Gerson was scarcely an unpredictable event. An immigrant
refugee physician from Germany appears in New York and, in a
few short years, opens a thriving Park Avenue practice using an
7
unconventional cancer therapy, opines loudly regarding the
health dangers of tobacco (Philip Morris was then the Journal of
the American Medical Association’s main source of advertising),12
and on top of that has the temerity to testify before Congress,
showing off his recovered patients who had failed on conventional
therapies. At the same hearing, others propose that $100 million
be spent to investigate apparently allied innovative approaches to
cancer; Gerson’s hospital chief offers testimony that no treatment
at all is better than conventional treatment for cancer; and
another witness warns the legislators not to let “any existing
medical organizations” (a clear reference to the AMA) control their
search.
Regardless of the merits of the Gerson therapy, mainstream
medical opinion at that time firmly held the view that nutritional
therapies had nothing to offer for cancer treatment, and to this
day the evidence for decisive, positive results from Gerson therapy
remains highly questionable. In contemporary studies, the
Gerson program emerges as a potentially useful complement to
conventional therapies. But even if, as Ward emphasizes, Gerson
was modest in his testimony regarding his claims for his therapy,
he allowed himself to be part of a very public critique of the
medical establishment of his time, and he did not disassociate
himself from testimony by others that his cases were “miracles.”
He and his colleagues should certainly have been aware of the
enormous political risk they were taking. Nor did the AMA attack
Gerson before he participated in this hearing before Congress.
Prior to that time, he was allowed to develop a thriving medical
practice using an alternative therapy for cancer and was affiliated
with a New York hospital. The point simply is that the
mythological view of some Gerson advocates that Gerson
discovered a “cure” for cancer and was, as a result, made the
innocent victim of an unprovoked witch-hunt by the AMA, does
not stand up to scrutiny, any more than does the view of Gerson
critics that he was simply a “quack” who deserved the
professional assault he received.
8
In my view, the question of Gerson’s motivations for participating
in the congressional hearings could benefit from further historical
inquiry. As a recent immigrant, Gerson was either naive about the
politics of American medicine, or very poorly advised, or he felt
that he had a great mission to accomplish to alert the American
public to the potential benefit of nutritional approaches to cancer,
and therefore went forward with the hearings despite full
knowledge of the dangers. It is not uncommon, among some of
the best-known practitioners of unconventional cancer therapies,
that they have, rightly or wrongly, a sense of mission that is
sometimes accompanied by a sense of personal invincibility and
self-confidence that can at times appear grandiose. Nor are
charismatic leaders in mainstream medicine any more exempt
from these particular characteristics.
For whatever reasons, Gerson, in participating in the
congressional hearings, undertook a course of action that
appears, at least in retrospect, professionally suicidal. History
cannot tell us what would have happened if he had quietly
continued his practice, strengthened his contacts with the
medical profession, and continued to publish a stream of
professional reports in which he made it clear that his nutritional
therapy for cancer was not a cure but deserved further evaluation
as a useful adjunctive cancer treatment. Instead, he died as
another martyr in the cause of alternative cancer therapies.
The Gerson Therapy
According to Gerson, in order to heal, “The body must by
detoxified–activated with ionized minerals, natural food so that
the essential organs can function. For healing the body brings
about a kind of inflammation. That is a tremendous
transformative reaction. This renders the body hypersensitive or
allergic to the highest degree against abnormal or strange
substances (including bacilli, cancer cells, scars, etc.).
Consequently the more malignant the cells, the more effective the
treatment.”13
9
The critical elements in the Gerson therapy are14:
1. Salt and water management through sodium restriction and
potassium supplementation.
2. High doses of micronutrients through frequent administration
of raw fruit and vegetable juices.
3. Extreme fat restriction.
4. Temporary protein restriction through a basic vegetarian diet.
5. Thyroid administration.
6. Frequent coffee enemas.
Raw calf’s liver juice, an iodine solution, thyroid extract, extra
potassium, pancreatin, and vitamin C were later added to the
regimen.15
A scholarly man, Gerson continuously explored the medical
literature of his day for explanations of why, in his experience,
this empirically derived nutritional treatment appeared to work to
the degree that some patients achieved cures and many others
had positive responses. He came to regard cancer as one of a
family of degenerative illnesses in which impaired metabolism
underlay the degenerative process. He believed that a number of
metabolic functions were deficient in cancer patients, including
the metabolism of fats, proteins, carbohydrates, vitamins, and
minerals. He also believed that oxygen-supplying enzymes had
been inactivated and that the vitality of intestinal bacteria had
been impaired.16
Gerson believed that his therapy reversed these elements of
impaired metabolism. But he also believed that, if the diet and
other medications were given without active detoxification, the
patient could often die from a liver overburdened by the toxins
being released from the body. He placed a central significance on
the health of the liver, and sought to stimulate the detoxification
of the liver by prescribing coffee enemas as frequently as every 3
or 4 hours, which he believed stimulated the release of bile and
10
aided in the release of toxins.17 In 1978, the editors of
Physiological Chemistry and Physics stated that “caffeine enemas
cause dilation of the bile ducts, which facilitates excretion of toxic
cancer breakdown products by the liver and dialysis of toxic
products from blood across the colonic wall.”18 Coffee enemas,
long a respected entry in the Merck Manual, represented to him a
logical component of the detoxification process. He emphasized
restoring the oxidative enzymes in the diet, since he believed
cancer cells grow in the absence of oxygen and can be inhibited or
destroyed by replenishing cellular oxygen supplies. He sought to
supply this oxygen using fresh organic fruit and vegetable juices
prepared with a stainless steel grinder and press.19
The third central element in Gerson’s effort to restore healthy
metabolism was balancing potassium and sodium in the body. He
believed that high- sodium, low-potassium diets contributed to
tumor growth, and that high- potassium, low-sodium diets and
potassium supplementation could help reverse the unhealthy
balance.20
Scientific Support for the Gerson Therapy
Because of the attack by the AMA, Gerson’s therapy was, for
decades, considered one of the prototypical “quack” cancer
therapies. But in recent years–as the nutritional research
literature on cancer quietly mounted behind doors closed by
professional prejudice against nutritional elements in cancer
therapy–an increasing number of physicians and researchers
have been asking whether Gerson may have had something to
contribute after all.
In 1980, writing in the same Journal of the American Medical
Association that had attacked Gerson, William Regelson, M.D.,
suggested that “we may shortly have to ask if Gerson’s low-
sodium diet, with its bizarre coffee enemas and thyroid
supplementation, was an approach that altered the mitotic
regulating effect of intracellular sodium for occasional clinical
validity in those patients with the stamina to survive it.”21
11
Similar suggestions, that a more favorable sodium-potassium
ratio (such as that created by the Gerson therapy) might affect
malignant mitogenesis, had been offered 9 years earlier by
Clarence D. Cone, Jr., writing in the Journal of Theoretical
Biology.22 In a series of studies, Cone found evidence that the
level of electrical polarization found in the membranes of healthy
cells was significantly higher than that found in the membranes
in proliferating cancer cells. This “electrical transmembrane
potential” can affect, among other things, the capacity of the cell
to keep sodium and potassium levels in healthy relationships
inside and outside the cell membranes.22 Basically, the healthy
cells had a high potassium and low sodium content and high
electrical polarization of their cell walls, while the cancer cells had
higher sodium, lower potassium, and lower electrical polarization.
In 1983, a molecular biologist named G.N. Ling wrote an article23
exploring the clinical implications of this emerging work and its
possible theoretical substructure. In it, he explained:
The recognition of cells as the basic unit of life implies that living
matter is not a continuous mass but consists of separate units.
This discontinuity between the cell and its aqueous environment
is selective in a subtle manner. Thus from the earliest days of
biology, it was recognized that water can move in and out of the
cells with relative ease. .ê.ê. It [later] became clear that the living
cell membrane is not just permeable to water but is also
permeable to a host of other solutes dissolved in water. The most
surprising of this new revelation concerns the permeability of
sugar, free amino acids, and salt, which at high strength cause
sustained cell shrinkage. .ê.ê.
If the cell membrane is permeable to a particular solute, one
expects that over a long period of time, this solute would reach
and be maintained in the cell wall at the same concentration as
that in the external medium. Yet old cells as well as young cells
share the striking characteristic of maintaining the same high
level of potassium and the same low level of sodium in the cell
water while the aqueous environment in which these cells are
12
bathed contains as a rule a low level of potassium and a high
level of sodium.23
Ling went on to propose a highly technical explanation of how the
relationship was maintained. This line of research was seized on
by F.W. Cope, M.D., in an article entitled “A Medical Application
of the Ling Association-Induction Hypothesis: The High
Potassium, Low-Sodium Diet of the Gerson Cancer Therapy.”24
Cope wrote:
This paper shows how modern work on cation association [i.e.,
the behavior of ions in a solution] and water structuring in cells
supports and makes more precise some of the deductions Gerson
made from his medical experiments with cancer patients. An
essential component of Gerson’s cancer therapy was the use of a
low sodium, high potassium diet. Indeed, he found experimentally
that cancers regressed faster if large quantities of inorganic
solutions of potassium were given in addition to a diet which was
already high in potassium.
Gerson attempted to understand the biochemical and biophysical
reasons for the observed success of low sodium and high
potassium diets in the cure of cancer. He recognized the
significance of this question and devoted much space in his book
to correlations with known experimental facts. He observed that
cancer patients always had marked degeneration of other tissues.
.ê.ê. Gerson made the general deduction that a major part of the
reason for the observed success of the low sodium, high
potassium diets in the treatment of cancer was that they forced a
correction of the generalized tissue damage .ê.ê.24
Tissue damage, from any cause and in any tissues, produces a
similar set of changes in tissue salt and water, which Cope called
“the tissue damage syndrome.”
The most easily observed components of the tissue damage
syndrome .ê.ê. are decreased cell potassium, increased cell
sodium, and increased cell water (cell swelling or tissue edema).
.ê.ê.
13
The high potassium, low sodium diet of the Gerson cancer
therapy is a logical strategy for improving the health of the body
tissues, of which probably all, and certainly the liver, are
suffering from the tissue damage syndrome. .ê.ê.
In the damaged or partly damaged cell, the cell proteins lose all or
part of the preference of their sites for associating with potassium
rather than sodium. Therefore if in the environment around the
cell the concentration of potassium is increased compared to
sodium, the association sites are forced to accept more potassium
and less sodium. .ê.ê. This tends to restore the normal
configuration of the proteins. Therefore treatment with the Gerson
diet to increase tissue potassium concentration and to decrease
tissue sodium concentration is a logical therapy for the tissue
damage syndrome in the cancer patient.24
Up to this point, I have reported primarily on hypotheses
concerning the molecular biology and chemistry of the Gerson
diet. There is evidence from clinical research as well.
In a 1983 study published in Cancer Research, a Hungarian team
led by Zs.-Nagy performed x-ray microanalyses of intraoperative
biopsy material from human thyroid cancers, and compared these
cells with normal human epithelial cells. They then compared the
levels of sodium and potassium in the malignant and normal
cells, and found that increasing levels of sodium in relation to
potassium were associated with increasing malignancy in the
human thyroid, thereby supporting Cone’s theories concerning
the relationship of cell membrane depolarization and rate of cell
division.25
Two years later, two researchers from the University of Texas
M.D. Anderson Cancer Center in Houston reported that high
concentrations of potassium altered the shape and the ability to
grow of rat kidney cells infected with aêsarcoma virus. High
concentrations of potassium returned 100% of the cellsêto their
normal structure. They also noted that other researchers
14
wereêreporting positive effects of high potassium concentrations
on cellular differentiation.26
A Partially Controlled Clinical Trial of a Modified Gerson Diet
The ultimate evaluation of the Gerson program must come from
controlled clinical trials. Recently, an enterprising surgeon in
Austria and his colleagues conducted what they admitted was a
flawed controlled clinical trial using patients from their own
practice who were willing to go on a modified Gerson diet.27
Dr. Peter Lechner and his colleagues of the Second Surgical
Department of the Landeskrankenhaus in Graz have used a
modified Gerson treatment for 4 years. They exclude the liver
juice, and, except in hypothyroidism, the routine thyroid
supplementation. They also exclude niacin “for fear of severe
bleeding complications–especially in patients with a derangement
of hemostasis caused by liver metastases.”
Our patients do not take more than two coffee enemas a day, one
in the morning and the other one in the afternoon not later than
5 P.M. to avoid disturbances of sleep. Four enemas a day led to
colitis in three patients in the very beginning of the therapy
[emphasis added].
We use the Gerson therapy not as an alternative but as an
additive treatment, e.g. often combined with chemo- and/or
radiation-therapies, and without exception in patients who had
operations before. So diagnosis is verified at least by tissue biopsy
in every single case.27
The 60 patients were male and female, 23 to 74 years of age, with
many types of cancer and many kinds of prior treatment. The
Gerson program was given on an outpatient basis, so the level of
compliance could not be carefully assessed. And Lechner warns
that they have used the therapy for only 4 years: “It is commonly
accepted that oncological treatments demand a period of
observation, documentation and evaluation of at least five or,
15
better, ten years before final conclusions can be drawn.” He
continues:
There is a very personal aspect, too: All our doctors are general
surgeons, thus being conservatively or even skeptically minded,
and none of us is an enthusiast as far as so-called alternative
methods are concerned. We do watch our patients very carefully
and from a rather critical point of view. For the same reason, we
try to learn more about how and why the therapy might work,
and we also do fundamental research work with special regard to
the coffee enemas in cooperation with leading physiologists and
biologists. Experiments performed in rats convinced us that two
constituents of the coffee enemas lead to an enhanced production
of bile. Applied rectally, these substances are absorbed into the
portal venous blood and accelerate the excretion of phenacetin
and some free radicals into the bile. Further data shall be
published in the near future.27
Lechner found that only a small percentage of their patients were
willing to follow the modified but still restrictive Gerson program.
Among the refusers, they sought patients whose cases were
similar to the Gerson patients so they could form “pairs” for the
sake of comparison. There are, as we will see, methodological
problems with this procedure. They surveyed 19 pairs of women
with breast cancer who had radical mastectomies, with type and
stage of malignancy verified in all cases. Of six pairs of
premenopausal women, all belonging to a high-risk group, one
Gerson patient (GP) developed a metastasis while three non-
Gerson patients (NGP) developed metastases. Of seven pairs of
premenopausal women, two NGPs had local recurrence and two
NGPs had metastases to the spine. Of six pairs of
postmenopausal women, none have shown further signs of
disease so far.
The GPs also showed markedly better tolerance for radiotherapy,
and especially chemotherapy. They did not show alterations in
liver or kidney function or depressions of red or white blood cell
count. Chemotherapy had to be interrupted with two NGP women
16
because of severe depression in the blood count. Clinical side
effects such as nausea, vomiting, loss of appetite and weight, and
loss of hair were seen three times more frequently in the NGP
group.
Among patients with liver metastases, GPs again showed
“significantly increased tolerance” for chemotherapy. Lechner said
this about the three pairs of patients with liver metastases: “Five
of the six women are dead by now–only one, a GP, is still alive,
her disease having been in a `no change’ state for fourteen
months. Her partner died more than eight months ago. In no case
did the Gerson Therapy lead to a complete remission, but the two
GPs survived their partners for at least twice the time [emphasis
added]. This might be an effect of the coffee enemas.”
Among four patients with metastases to the lungs, a condition
that usually causes pleural effusion of fluids and a need for
puncture and drainage, “the two NGPs had their hydrothorax
punctured twice as frequently as the GPs. The much slower
recurrence of the effusion in GPs might be a result of the strict
avoidance of dietary sodium.”
Two patients had brain metastases:
The GP “recovered” for a period of three months, and most of the
symptoms disappeared. CT-scan showed that peritumorous
edema was reduced by more than 30%. The underlying
mechanism might be the same as it is in pleural effusions. Both
patients died, the GP four months later than the NGP.
Metastases to the bone are very frequently seen, and so we had
12 pairs of patients who belong to this subtype. This kind of
tumor, usually treated with chemotherapy, responds only poorly
to the Gerson therapy [emphasis added]. There is no significant
difference between the NGP and the GP group as far as tumor size
and survival are concerned. Only the quality of life seems to be
better in the GP group, probably for two reasons: (1) The coffee
enemas, taken twice a day, give some pain relief so that most of
the GPs only need low doses of non-steroidal antirheumatics
17
(aspirin or other similar analgesics). They usually do not take
alkaloids, so that they can lead quite an active life in spite of their
disease. (2) Hypercalcemia, which can alter kidney function, does
not occur in GPs, maybe as a result of the intake of more than
two litres of juices per day.27
Among patients with colorectal carcinoma, Lechner found no
significant difference between the two groups regarding local
recurrences or distant secondary metastases. “After the
operation, GPs usually recover better than NGPs and seem to gain
weight more easily.” This observation of improved weight gain in
Gerson patients is intriguing, given the concerns I have previously
expressed regarding the potential for weight loss in the radical
nutritional therapies.
“Patients with metastases in the liver seem to be the best
responders to the Gerson therapy,” Lechner found. After radical
surgical resection, Lechner’s patients are no longer given
intravenous or intraarterial chemotherapy, “the results having
been rather poor in the past.” For most patients–except those
opting for liver transplants–“the Gerson therapy remains the only
treatment. .ê.ê. We have already surveyed eight pairs by now, ten
men and six women between 32 and 74 years of age. The
laboratory findings of all of them show significant differences
between the GP and NGP groups.” Lechner continues:
The hepatic enzyme profiles, in four patients more than four
times beyond the normal range at the beginning of treatment,
became completely normal in the two GPs within four months
and remained so for more than one year. One of the two women
had her gallbladder removed and .ê.ê. died of liver failure. The
other is still leading an active life. Ultrasound and CT-scan show
no growth of the metastases.
In another four pairs success was not so evident; the enzyme
profiles remained high and the disease was apparently
progressing. Although all these patients died within two years
after operation, lifespan of the GPs was in all cases more than
18
double the NGPs. As described in breast cancer patients, the GPs
usually needed less analgesic drugs than the NGPs and, as a
result of the regularly applied enemas, none of them developed a
bowel obstruction although two of them suffered from far
advanced peritoneal carcinosis. Among the last four patients of
this subtype there is one of the GPs who came into a complete
remission and remained in this state for about half a year. .ê.ê.
Among all our patients this is the only one where the Gerson
therapy might have had a tumoricide effect, but we tend to
interpret this as a “spontaneous remission” rather than as the
result of the dietary treatment.27
Lechner’s account is worthy of careful consideration. There are
methodological problems with selecting the “pair” for each Gerson
patient from the patient who turned down Gerson treatment.
Among the GPs there may simply have been a higher motivation
to live. On the other hand, Lechner has at least provided an
invaluable rough estimate of the effects of a modified Gerson
therapy over 4 years with 30 pairs of patients.
From his experience, Lechner found significant advantages for
Gerson patients. Some lived longer. Others were healthier, had
better responses to conventional therapies and fewer side effects,
less pain, and better quality of life. Some of these advantages
seemed directly related to the Gerson regimen. But the
psychological and physical characteristics that enabled these
people to undertake the regimen undoubtedly played a part in the
superior results in many categories.
These findings, while significant, are a far cry from the dramatic
results claimed by Gerson or claimed in his name by colleagues
and admirers while he was alive and leaders of the Gerson
Institute after his death. At the same time, Robert Houston has
properly pointed out that Lechner did use a reduced therapy and
also combined it with chemotherapy and radiation, both of which
are immunosuppressive. Any immune enhancement brought
about by the Gerson program itself may therefore have been
compromised by its use as complementary therapy.28
19
Claims for the Gerson Diet
The question of what Gerson claimed and what others claimed in
his name is confusing. Gerson himself said different things in
different places as his experience with the treatment evolved. In
an early report, published in 1949, he said: “The difficulty of
evaluating any therapy, especially in a disease so protean in
character as cancer, is fully appreciated by us. It is too early to
make any definitive statement as to the value of the Gerson
Dietary Regime at this time, but we hope to be able to report a
sufficient number of cases later to allow statistical analysis.”29
By the time he was rewriting A Cancer Therapy near the end of
his life, Gerson wrote: “This book has been written to indicate
that there is an effective treatment for cancer, even in advanced
cases.” What does that mean? If we look at Lechner’s results in
Austria, it might be fair to call the Gerson therapy an “effective
treatment,” just as a chemotherapy that enhances outcomes
significantly over other chemotherapies may be described as an
“effective treatment.” But Gerson writes those words in the
context of presenting 50 cases of advanced cancer patients whom
he regarded as individually “cured” by treatment. And a lecture
given in 1956 was entitled, “The Cure of Advanced Cancer by Diet
Therapy.” In it Gerson said: “I should like to tell you what we do
to prove that this treatment really does work for cancer. Number
one, the results. I think I can claim that I have, even in these far
advanced cases, 50% results. The real problem arises when we
cannot restore the liver.”30
What does Gerson mean by “50% results” in far-advanced cases?
Gerson explains: “The number of terminal cases among my
patients increased to more than 90 per cent of the total, having
come to me after the applied treatments had failed. .ê.ê. About 50
per cent of these cases could be improved and saved; the
percentage could be higher if there were better cooperation from
the family physician, the patient himself, and less resistance from
the family against such a strict regime.”31 Gerson believed that
he had accomplished a rate of cure of 50% for advanced cancers
20
after mainstream treatments had failed. I find this claim very
difficult to believe.
There is the further question of just how strong the evidence was
in the 50êcases that Gerson presented in A Cancer Therapy as
among his best cases. Mark F. McCarty, of the McNaughton
Foundation, offered the following comment:
Dr. Gerson published 50 cases which he believed best
documented the success of his methods. A survey of these cases
shows that many of them offer less than adequate evidence of
response to the diet: recent prior treatment with standard
modalities occurs in some cases; lumps or radiological findings
appearing after surgical extirpation of the primary tumor are
often assumed to indicate recurrence without proof; a few cases
were never biopsied; and several were of tumor types that
occasionally remit spontaneously. Nevertheless, barring outright
deception on Gerson’s part (and it was generally admitted by his
opponents that Gerson was sincere), it is my impression that at
least some of these cases indicate objective tumor regression in
response to the Gerson methods. At a Senate Select Committee
hearing on cancer research in 1945, five independent M.D.s who
had personal experience with patients treated by Gerson
submitted letters indicating that they had been surprised and
encouraged by the results they had seen, and urged a widespread
trial of the method. One of these doctors claimed that relief of
severe pain was achieved in about 90% of cases. No controlled
trial of Gerson’s methods was ever undertaken.32
Gar Hildenbrand, the scholarly current director of the Gerson
Institute, believes that the results the Gerson Institute is getting
today are analogous to those Gerson achieved. But neither he nor
other long-time observers of the Gerson program suggest that
they achieve anything approaching cure in 50% of advanced
cancer patients.
Scientific Evaluations of the Gerson Program
21
In 1987, Gar Hildenbrand undertook an important and ambitious
“best-case” review of patients on the Gerson program. The review
was intended to focus on patients who had either had no previous
conventional treatment or who had not been helped by previous
conventional treatment.33 The study was a heroic undertaking,
and doubly important because it represented one of the most
important efforts so far by a proponent of an alternative cancer
therapy to design, fund, and carry out a major assessment of the
objective benefits of the therapy. Unfortunately, the study turned
out to be impossible to complete because the Gerson practitioners
were relying on blind recall as to who had done well on the
program, the number of “pure” cases in which neither allopathic
intervention nor the natural history of the disease could possibly
account for the favorable outcome was very small, complete
records for patients seen over many years are very difficult and
extremely expensive to get, and necessary reassessment is even
more difficult and expensive. The study demonstrated the
difficulties inherent in the full-scale best-case review as a prelude
to controlled clinical trials or other formal evaluations.
In 1989, an objective and qualified British research team headed
by Karol Sikora, Professor of Clinical Oncology at the Royal
Postgraduate Medical School, University of London, visited the
Gerson Clinic on behalf of a British insurance company. They
observed clinic operations freely and were offered information
from the files on what were considered by the clinic staff to be the
best cases of the Gerson treatment. In addition to their best-case
study, the researchers conducted a psychological assessment of
patients currently at the clinic:
During our assessment we had free access to all the inpatients
and their notes, and also a sample of notes gathered as examples
of best responses. Out of a total of 3000 patients treated since
1974, 149 case histories were examined, having been selected by
the Gerson Institute on the basis of replies to a postal
questionnaire sent to patients over the past two years. The
commonest tumours were melanoma (24), breast carcinoma (29),
22
colorectal cancer (21), prostate cancer (11), and lung cancer (15).
.ê.ê. Of the patients responding, 27 had independent
documentation of their disease status from their “conventional”
physicians and thus were assessable according to standard
oncological criteria [see table 14.1].34
In their psychological study, the researchers found a very marked
enhancement of quality of life and of pain control without the
need for opiates, even in advanced cancer:
Psychological information was obtained from the patients present
at the centre. .ê.ê. [A] striking feature was the high degree of
control the patients felt they had over their health and, perhaps
as a consequence, their high ratings for mood and confidence.
Particularly intriguing were the low pain scores and analgesic
requirements for all the patients, despite the presence of
extensive metastatic disease in many and the fact that several
had been on opioid medication previously.34
In terms of tumor response to the therapy, the researchers
concluded:
We could find little objective evidence of an antitumour effect
from the Gerson therapy, although most patients were not
assessable because of concomitant conventional therapy.
However, in a few patients definite tumour regression was
documented. In view of the poor prognosis of most of the patients,
perhaps it is more important that there was a subjective benefit
both to them and to their families. There is evidence that a
“fighting spirit” response is associated with a better prognosis,
and Spiegel and co-workers have shown that patients with
metastatic breast carcinoma treated with psychotherapy in
addition to conventional chemotherapy had a significantly
improved survival. Judged in this context, the improvement in the
Gerson patients’ sense of wellbeing may take on a greater
importance.34
The researchers pointed out that the example of the Gerson
therapy did demonstrate a “way forward” for oncology practice:
23
“The nature of the therapy requires a positive contribution to be
made by the patient to his or her health and meets a need not
satisfied by conventional therapy, in which the role of the patient
is essentially passive. These approaches may suggest ways
forward for oncologists in the management of desperate cancer
patients and their families.”34
Conclusion
I undertook this extended review of the Gerson therapy for several
reasons. First, the Gerson therapy is the oldest and best known of
the modern Western alternative nutritional therapies for cancer,
and there is more scientific information available on it than for
most other nutritional treatments. Second, the complexities of
evaluating the therapy, the historical and scientific issues, are
similar to those raised by many other nutritional therapies. Third,
in my judgment, the evaluation suggests the general range in
which we might expect outcomes to be achieved with other
intensive nutritional therapies.
What conclusions can we reach? I suggest that the most
reasonable conclusion based on the currently available evidence,
which is suggestive, but not definitive, is that the Gerson therapy
sometimes enhances outcomes for patients with some types of
cancer who have the stamina and the willingness to undertake it.
Also, we can conclude that the Gerson therapy does not approach
being a decisive cure for any type of cancer.
If adequate controlled clinical trials of the Gerson therapy are
undertaken by open-minded and reasonably sympathetic
researchers who have carefully studied the cancers in which
Gerson therapy seems to yield the best results, I predict that the
therapy will prove to be a significant adjunct to the judicious use
of conventional therapies for those cancers. Further, it may also
improve outcomes for some cancers where conventional treatment
would bring few–if any–results. And I believe it would prove a
legitimate option in some cancers where standard modalities have
demonstrated only limited efficacy–in, say, 10% to 25% of cases–
24
but the costs in toxicity and quality of life are very high. I also
predict that in controlled clinical trials, there would be a small
but significantly increased number of cures, along with a wide
range of increases in life expectancy and improved quality of life.
Gar Hildenbrand, current executive director of the Gerson
Institute, has expressed his view that the Gerson therapy is a
necessary adjunct to standard modalities. This move away from
the original claims of cure is an important move toward a
scientific middle ground. One day, the Gerson therapy may be
recognized as being of supreme historical importance in the
recovery of the nutritional component in cancer management.
However, I believe it will prove to be only one version of a
necessary adjunctive nutritional treatment. There are and will be
other adjunctive nutritional treatments, and some may ultimately
prove to be better approaches than Gerson’s. I believe Max
Gerson, the great pioneer of nutritional cancer therapies, the
scholar’s scholar, and the supreme empiricist who believed that
results at the bedside were decisive, would be content to be
remembered that way.
Albert Schweitzer said: “I see in Dr. Max Gerson one of the most
eminent geniuses in medical history.”35 If one immerses oneself
in Gerson’s writings, the writings about him, and the scientific
mystery story we have set out to unravel here, it is not difficult to
see why he has inspired such admiration. He was a profoundly
ethical man who helped recover for our time the great healing
potential of a nutritional medicine based on the conventional
scientific understanding of his time and on his own empirical
experience. He sought to modernize and understand nutritional
therapy in the context of a commitment to science and to his
patients with cancer.
Notes and References
1 In October 1989, the Gerson Institute issued instructions to all
patients to substitute carrot juice for calf’s liver juice obtained
from growers in the United States. This decision was based on
25
multiple outbreaks of bacterial infections at the Hospital de Baja
California where liver juice was part of the therapy. Liver juice
was added to the therapy by Gerson in 1950 in the belief that the
nutritional quality of fruits and vegetables was declining due to
modern farming practices. According to the Gerson Institute, the
rise of modern organic farming holds out the promise of higher-
quality fruits and vegetables than were available during Gerson’s
lifetime.
2 Patricia Spain Ward, “History of Gerson Therapy,” contract
report for the U.S. Congress Office of Technology Assessment
(OTA), revised June 1988. This report created a storm of
controversy at OTA when a staff member commented in writing
that the paper seemed unduly favorable to Gerson, and
proponents of alternative therapies vigorously protested the
comment as evidence of bias against Gerson and against
alternative therapies more generally. Rosemary Stevens, Ph.D.,
chair of the OTA Advisory Panel on the Unconventional Cancer
Therapies Report subsequently commented at an open review
session that Ward’s paper was a professionally competent review
of the subject.
13 Max Gerson, A Cancer Therapy: Results of Fifty Cases (Del
Mar, CA: Totality Books, 1977), 7-10.
14 Gar Hildebrand, “Let’s Set the Record Straight, Part 5–Bread,
Propaganda and Circuses,” The Healing Newsletter, The Gerson
Institute, March-June 1987.
15 Max Gerson, “Effects of a Combined Dietary Regime on
Patients with Malignant Tumors,” Experimental Medicine and
Surgery 7(4):299-317 (1949). Cited in U.S. Congress Office of
Technology Assessment, Unconventional Cancer Treatments
(Washington, D.C.: Government Printing Office, September 1990),
45.
16 Max Gerson, “Cancer, A Problem of Metabolism,” translated
from Medizinische Klinik 49(26):1028-32 (1954). Cited in Office of
Technology Assessment, Unconventional Cancer Treatments, 45.
26
17 Max Gerson, “The Cure of Advanced Cancer by Diet Therapy:
A Summary of 30 Years of Clinical Experimentation,”
Physiological Chemistry and Physics 10:449-64 (1978). Cited in
Office of Technology Assessment, Unconventional Cancer
Treatments, 45-6.
18 Freeman W. Cope, “A Medical Application of the Ling
Association-Induction Hypothesis: The High Potassium, Low
Sodium Diet of the Gerson Cancer Therapy,” Physiological
Chemistry and Physics 10:465-68 (1978).
19 Gerson, “The Cure of Advanced Cancer by Diet Therapy,” 46.
21 William Regelson, “The `Grand Conspiracy’ Against the Cancer
Cure,” Journal of the American Medical Association 243(4):337-9
(1980).
22 Clarence D. Cone, Jr., “The Role of the Surface Electrical
Transmembrane Potential in Normal and Malignant Mitogenesis,”
Annals of the New York Academy of Sciences 420-32 (1971).
23 G.N. Ling, “The Association-Induction Hypothesis: A
Theoretical Foundation Provided for the Possible Beneficial Effects
of a Low Sodium, High Potassium Diet and other Similar
Regimens in the Treatment of Patients Suffering from Debilitating
Illnesses,” Agressologie 24(7):293-302 (1983).
24 Cope, “A Medical Application of the Ling Association-Induction
Hypothesis: The High Potassium, Low Sodium Diet of the Gerson
Cancer Therapy,” Physiological Chemistry and Physics, 465.
25 Imre Zs.-Nagy et al., “Correlation of Malignancy with
Intracellular Na-K Ratio in Human Thyroid Tumors,” Cancer
Research 43:5395-7 (1983).
26 Chiu-Nan Lai and Frederick F. Becker, “Potassium-Induced
Reverse Transformation of Cells Infected with a Temperature-
Sensitive Transformation Mutant Virus,” Journal of Cellular
Physiology 125: 259-62 (1985).
27
27 P. Lechner, “The Role of a Modified Gerson Therapy in the
Treatment of Cancer.” Typescript, Second Department of Surgery,
Landeskrankenhaus, Graz, Austria, 1987.
28 Robert Houston, personal correspondence with the author, 4
May 1991.
29 Max Gerson, “Effects of a Combined Dietary Regimen,”
Experimental Medicine and Surgery, 299-315 (1949).
30 Max Gerson, “The Cure of Advanced Cancer by Diet Therapy:
A Summary of 30 Years of Clinical Experimentation,”
Physiological Chemistry and Physics 10:449-63 (1978).
31 Gerson, A Cancer Therapy, 33.
32 Mark F. McCarty, “Aldosterone and the Gerson Diet–A
Speculation,” Medical Hypotheses 7:591-7 (1981).
33 Office of Technology Assessment, Unconventional Cancer
Treatments, 50.
34 Alison Reed, Nicholas James, and Karol Sikora, “Mexico:
Juices, Coffee Enemas, and Cancer,” letter to the Editor, Lancet
336:676-7 (September 15, 1990).
35 Gerson, A Cancer Therapy, cover.
28
http://www.coffee-enema.ca/history_gerson_therapy.htm
History of The Gerson Therapy
by Dr. Patricia Spain Ward
It is one of the least edifying facts of recent American medical
history that the profession's leadership so long rejected as
quackish the idea that nutrition affects health (JAMA 1946 1949,
1977; Shimkin, 1976). Ignoring both the empirical dietary wisdom
that pervaded western medicine from the pre-Christian
Hippocratic era until the late nineteenth century and a persuasive
body of modern research in nutritional biochemistry, the
politically minded spokesmen of organized medicine in the U.S.
remained long committed to surgery and radiation as the sole
acceptable treatments for cancer. This commitment persisted,
even after sound epidemiological data showed that early detection
and removal of malignant tumors did not "cure" most kinds of
cancer (Crile, 1956; updated by Cairns, 1985).
The historical record shows that progress lagged especially in
cancer immunotherapy - including nutrition and hyperthermia -
because power over professional affiliation and publication (and
hence over practice and research) rested with men who were
neither scholars nor practitioners nor researchers themselves,
and who were often unequipped to grasp the rapidly evolving
complexities of the sciences underlying mid-twentieth-century
medicine.
Nowhere is this maladaption of professional structure to
medicine's changing scientific context more tragically illustrated
than in the American experience of Max B. Gerson (1881- 1959),
founder of the best-known nutritional treatment for cancer of the
pre-macrobiotic era. A scholar's scholar and a superlative
observer of clinical phenomena, Gerson was a product of the
German medical education which Americans in the late 19th and
early 20th centuries considered so superior to our own that all
who could afford it went to Germany to perfect their training
(Bonner, 1963). As a medical graduate of the University of
29
Freiburg in 1909, Gerson imbibed all of the latest in scientific
medicine, with the emphasis on specificity which bacteriology had
brought into western medical thought in the preceding decades.
Gerson subsequently worked with leading German specialists in
internal medicine, in physiological chemistry, and in neurology
(U.S. Congress, 1946, 98). The historical record does not tell us
whether his medical education in Germany (where much of the
early work in nutritional chemistry took place) included a study of
diet, a subject neglected in American medical schools after the
germ theory gained acceptance.
We do know that by 1919, when Gerson set up a practice in
internal and nervous diseases in Bielefeld, he had devised an
effective dietary treatment for the migraine headaches which
frequently disabled him, despite the best efforts of his colleagues.
In 1920, while treating migraine patients by this salt-free
vegetarian diet, he discovered that it was also effective in lupus
vulgaris (tuberculosis of the skin, then considered incurable) and,
later, in arthritis as well (U.S. Congress, 1946, 98).
Trained in the theories of specific disease causation and
treatment that began to dominate western medicine - for the first
time in history - as bacteriological discoveries multiplied in the
late nineteenth century, Gerson was at first uneasy about using a
single therapy in such seemingly disparate conditions. But he
was committed to the primacy of clinical evidence, which he liked
to express in Kussmaul's dictum: "The result at the sick-bed is
decisive" (quoted in Gerson, 1958, 212). In later years, after
research began to provide explanations for Gerson's clinical
observations, he quoted Churchill on the mistaken course of
action he had thus avoided: "Men occasionally stumble over the
truth, but most pick themselves up and hurry off as if nothing
had happened" (Gerson, 1958, 212). Gerson persisted. In 1924
his success in treating tuberculosis of the skin brought an
invitation from the noted thoracic surgeon, Ferdinand
Sauerbruch, to test Gerson's diet in a special lupus clinic to be
provided by the Bavarian government at the University of Munich.
30
As Sauerbruch recounts it in his autobiography, 446 patients out
of 450 recovered - once he had discovered and put an end to the
smuggling of sausages, cream and beer to the patients in the late
afternoons ( Sauerbruch, 1953, 167- 171 ). Later extended to
pulmonary tuberculosis as well, this Gerson-Sauerbruch-
Hermannsdorfer diet was widely used in Germany and became
the subject of Gerson's first book in 1934 (Gerson, 1934;
Hildenbrand, 1987 communication).
During the late twenties and early thirties Gerson had several
experiences which informed his later thinking on diet and
degenerative disease. As a member of the State Board of Health,
appointed by the Prussian government, he was given
extraordinary laboratory support for a clinical trial of diet in
pulmonary tuberculosis. Besides the physiological parameters
customarily monitored in such work, Gerson was able to track
minute fluctuations in the patients' mineral metabolism and also
in the chemical composition of the foods he prescribed (Gerson,
1958, 183). At this same period he served as consultant to the
Prussian Ministry of Health on the best ways to restore to
agricultural usefulness the exhausted soil around several major
German cities (Gerson, 1958, 183). When he learned that modern
farming methods often rob plant foods of their natural mineral
and vitamin riches, while increasing their sodium content, he
began to think of the earth's well-being as central to our own.
Eventually he began to refer to the soil, which nourishes the food
we eat, as our "external metabolism" (Gerson 1958, 175).
It was in 1928 that Gerson first used his diet in cancer, at the
insistence of a woman who had jaundice, high fever and two
small liver metastases after unsuccessful surgery for cancer of
the bile duct (Gerson, 1958, 31). On the strength of reports she
had heard of Gerson's work with tuberculosis, this woman
insisted that he write out a diet for the treatment of her cancer.
Gerson reluctantly agreed - after he obtained her signed
statement that she would not hold him responsible for the
outcome! As he recalled it many years later, this same patient
31
had him read aloud to her a chapter called "The Healing of
Cancer" from a big book of about 1200 pages on folk medicine, "
edited by three schoolteachers and one physician, none of them
practitioners. It was from this source that Gerson first learned of
the special soup which Hippocrates supposedly gave to cancer
patients and which Gerson made a fixture of his cancer Therapy
(Gerson, 1958, 31, 403-404; Gerson, 1978, 449-450). Having
taken up this challenge against his will, with no hope of success,
Gerson was astounded when his patient seemed fully recovered
within six months (Gerson, 1958, 405). In quick succession he
had the same good results with two patients with inoperable
stomach cancer, both referred by this first patient. Late in life he
continues to marvel at these apparent recoveries under his diet
treatment (Gerson, 1958, 404- 405). (These notable histories,
which Gerson recounted in some detail, have prompted one
recent researcher to suggest the possible involvement of
aldoslerone as the mechanism of mineral-corticoid sensitivity in
gastrointestinal tumors. See McCarty, 1981).
In Vienna, where he lived for a time after the rise of Hitler,
Gerson's treatment failed in all seven patients he attempted to
treat in this manner - a failure which, in later years, he attributed
to inadequate dietary provisions in the sanitarium where he then
worked (Gerson, 1958, 31-32, 405). In Paris, where he lived in
1935-36, the diet produced good results in three out of seven
cases (Gerson, 1958, 32, 405; Gerson, 1978, 451), inspiring him
to pursue such treatment further after he emigrated to the United
States in 1938.
Gerson constantly sought explanations for his observations in the
scientific literature, where he read widely in several languages
(Gerson, 1958). In 1954, in "Cancer, a Problem of Metabolism," he
credited J. Maisin (1923) and B. Fischer-Wasels (1929) with
advancing physiological explanations of general predisposition
toward tumor formation and abandoning the theory of cancer
causation by local irritation. For the next few decades (according
to Gerson's account of the evolution of cancer concepts) there was
32
a tendency to interpret cancer in terms of constitution and
diathesis, as was done with diabetes, gout and tuberculosis. It
was Caspari (Nutrition and Cancer, 1938) who turned to
metabolic explanation of the kind Gerson ultimately favored
(Gerson, 1954, 1). He devoted an entire chapter of his book to a
review of efforts, largely by German researchers, to alter
metabolism by diet (Gerson, 1958, 89-104). He found special
appeal in Otto Warburg, The Metabolism of Tumors, (London,
1930), in G. von Bergmann's Funktionelle Pathologie (Berlin,
1932), and in Frederick Hoffman's massive compilation, Cancer
and Diet (Baltimore, 1937). Gradually, out of his bedside
experience and his reading, he formed a unitary theory of
degenerative disease (including cancer) which rested on one of the
oldest and most pervasive concepts in the history of medicine: the
vis medicatrix naturae or healing power of nature (Neuburger,
1926 and 1944; Warner, 1978). Endlessly seeking out the latest
researches and theories in physiology, biochemistry, and -
increasingly - immunology, Gerson rapidly integrated these
massive bodies of new detail into the larger framework of what he
called "the physician within", that is, the natural powers of
resistance, which we today call the immune system.
Gerson believed that cancer changes the body's normal
sodium/potassium balance, already disturbed by modern diet.
Thus his therapy used foods low in sodium (no salt added), high
in potassium, and rich in vitamins A and C and oxidizing
enzymes. He excluded fats and dairy products for the first four to
six weeks, considering them dangerously burdensome to the
digestion in the extremely sick patients who usually came to him
only after having exhausted conventional measures. Above all it
was essential for patients to eliminate excess sodium, which
Gerson believed responsible for altering cellular electrochemistry
in favor of cancerous growth.
There is now a great deal of research suggesting possible
mechanisms for the efficacy of Gerson's high potassium/low
sodium diet. As he suspected and we now know, hypokalemia
33
often accompanies cancer of the colon, and alterations in
electrical and mineral states occur often in cancer patients
(Newell, 1981, 87). Cone has furnished experimental proof of a
correlation between the level of electrical potential across somatic
cell membranes and the intensity of mitotic activity (Cone, 1971 ),
a finding supported by Zs.-Nagy and his colleagues in studies so
human thyroid cancer (Zs. -Nagy, 1983) . Ling's
association/induction hypothesis is based on laboratory studies
which show that damaged cells partially return to their normal
configuration in high potassium/low sodium environments (Ling,
1943), perhaps explaining the remarkable tissue repair which
Gerson sometimes saw in his formerly debilitated patients (Cope,
1978). Lai has suggested that intracellular sodium and potassium
levels may furnish the mechanism for regulating cellular
differentiation and transformation (Lai, 1985) .
To supply active oxidation enzymes and potassium-rich minerals,
Gerson's patients drank hourly glasses of freshly prepared
vegetable and fruit juices. As early as 1933-34, while living in
Vienna, Gerson had begun giving injections of liver extract, as
another means of stimulating the patient's liver (Gerson, 1958, 31
-32). In later years he had patients drink two to three glasses
daily of the juice of calves' liver pressed with carrots. In addition
to beta-carotene/vitamin A, this would supply iron and copper,
both of which affect peripheral T cell functions and other
peripheral lymphocyte subpopulations (Keusch, 1983, 345- 347).
Although the AMA Council on Pharmacy and Chemistry labeled
as a "false notion" the idea that diet can affect cancer, recent
researchers have found that "nutritional status plays a critical
role in immunological defense mechanisms at a number of
important levels" (Keusch, 1983, 345) and that nutritional factors
"can have profound influences on ... the development and
manifestations of cancers" as well as other diseases (Good, 1982,
85). In "The Cancerostatic Effect of Vegetarian Diets" ( 1983),
Siguel describes as the ideal way to strengthen bodily defenses
34
against neoplastic cells a diet similar to Gerson's: high in
carbohydrates and vegetables, low in protein.
Like von Bergmann, Gerson believed that "every defense and
healing power of the body depends on the capacity of the body to
produce a so-called 'allergic inflammation'"- a truth long
recognized by surgeons, but somehow forgotten by medicine
during the heyday of microbiology. To Gerson this capacity to
produce inflammation was "the decisive part of the body's
'weapon of healing power'" (Gerson, 1958, 127-28).
Noting that fluid from a normal inflammation metabolism kills
cancer cells, but that blood serum does not, von Bergmann
concluded that a cancer metabolism occurs when the body can
no longer produce this healing inflammatory reaction (Gerson,
1958, 120- 121 ). Gerson agreed, but in contrast to von
Bergmann and most of his contemporaries, Gerson believed it
was often possible for the physician to help restore the vital power
of inflammation, even in anergic patients with advanced cancer. If
cancer was a degenerative disease caused by the cumulative
effect of inadequate nutrition with foods grown in soils depleted
by artificial fertilizers and poisoned by toxic insecticides and
herbicides, doctors must respond by replenishing the entire
human organism. For a condition that represented an ultimate
failure of equilibrium in a poisoned metabolism, removal of
tumors by surgery or radiation was merely superficial,
symptomatic treatment. "Medicine," Gerson said, "must be able to
adapt its therapeutic methods to the damages of the processes of
our modern civilization" (Gerson, 1958, 199).
Gerson set about doing this by altering the basic diet he had used
earlier in other conditions. Through meticulous observation of his
patients in New York (where he passed state boards in 1939), he
perfected a regimen of detoxification and diet requiring a high
degree of compliance by the patient, heroic devotion by the
patient's family, and close attention and frequent adjustment by
the physician. His therapy aimed to detoxify the body and restore
35
its healing apparatus, especially the liver, the visceral nervous
system, and the reticulo-mesenchymal system.
Gerson first encountered the idea of detoxication in cancer in the
version of Hippocratic regimen which he read with his first cancer
patient in Bielefeld in 1928 (Gerson, 1958, 404). After losing
several cancer patients to hepatic coma rather than to direct
effects of the disease (Gerson, 1958, 191 ), he realized that "The
digestive tract is very much poisoned in cancer'. The liver and
pancreas failed to function: "nothing is active" (Gerson, 1958,
407). To stimulate the liver, he began to use coffee enemas, which
0.A. Meyer of Goettingen had found effective in opening the bile
ducts in animals and which American surgeons in that period
were using in acute adrenal insufficiency and in shock from
postoperative hemorrhage and bleeding peptic ulcer (Beeson,
1980, 90, 96; Rothstein, 1987, 124). As he watched the progress
of his patients, he found that he could accelerate detoxication by
giving coffee enemas more frequently, with the addition of castor
oil, by mouth and by rectum (Gerson, 1958, 81).
Although Gerson used caffeine enemas primarily to facilitate
excretion of toxic wastes, especially from necrosing tumors, we
now realize that these enemas also promoted the absorption of
vitamin A, a process requiring the action of bile acids (Simone,
1943, 64). Thus the enemas that brought ridicule from Gerson's
enemies actually enabled his patients to use the enormous
amounts of vitamin A which his diet provided (recently estimated
at about 100,000 IU daily: see Seifter, 1988). Vitamin A, in turn,
plays a vital role in immune function, perhaps by causing the
helper cells to induce the production of interleukin-2, or by
causing killer cell precursors to activate cytotoxic mechanisms, or
by causing suppressor T cells to eliminate down regulation
(Keusch, 1983, 330-331 ).
Gerson also found that caffeine enemas greatly reduce pain, a
particular boon in his regimen, which avoids the use of opiates
and other painkilling drugs that might overtax the liver at a time
36
when its limited capacity is needed for immune functions and for
eliminating the toxic products of tumor breakdown.
Although the AMA Council on Pharmacy and Chemistry labeled
as a "false notion" the idea that diet can affect cancer, recent
researchers have found that "nutritional status plays a critical
role in immunological defense mechanisms at a number of
important levels" (Keusch, 1983, 345) and that nutritional factors
"can have profound influences on ... the development and
manifestations of cancers" as well as other diseases (Good, 1982,
85). In "The Cancerostatic Effect of Vegetarian Diets" ( 1983),
Siguel describes as the ideal way to strengthen bodily defenses
against neoplastic cells a diet similar to Gerson's: high in
carbohydrates and vegetables, low in protein.
Gerson gradually added a few medications to his diet. One of
these was niacin, which he believed would help restore proper
intracellular potential, raise depleted liver stores of glycogen and
potassium, and aid in protein metabolism (Gerson, 1958, 32, 99-
100, 209). Another was iodine, which Gerson initially used only in
cases of low metabolic rates. When he found that "The best range
of healing power" was a BMR of +6 to +8 (monitored by organic
iodine in blood serum), and that iodine seemed to counteract the
neoplastic effect of hormones, he incorporated iodine into the
basic regimen, at first in the form of thyroid extract, later as
inorganic Lugol's solution (iodine plus potassium iodide) (Gerson,
1958, 32, 409; U.S. Congress, 1946, 114). Several researchers
have showed that thyroid raises natural resistance to infection by
augmenting the power of reticuloendothelial cells and by
increasing antibody formation - thus supporting Gerson's hunch
that iodine was a decisive factor in the normal differentiation of
cells (Lurie, 1960; Thorbecke, 1962).
Despite the fact that he had no inpatient facility until 1946, when
he opened a clinic in Nanuet, New York, Gerson managed,
through his thriving Park Avenue practice and an affiliation at
Gotham Hospital, to amass enough data to publish a preliminary
report in 1945. He presented his rather remarkable case histories
37
modestly, concluding that he did not yet have enough evidence to
say whether diet could either influence the origin of cancer or
alter the course of an established tumor. He claimed only that the
diet, which he described in considerable detail, could favorably
affect the patient's general condition, staving off the
consequences of malignancy and making further treatment
possible (Gerson, 1945).
Gerson may have struck an Establishment nerve with his
statement that many physicians use surgery and/or radiation
"without systematic treatment of the patient as a whole" (Gerson,
1945, 419). But it seems more likely that it was his growing
success in practice, or perhaps even his opposition to tobacco,
that first drew the wrath of organized medicine. ( Philip Morris
was then JAMA's major source of advertising revenue: see Rorty,
1939, 182 - 194).
In any case the AMA did not openly attack Gerson until November
1946, a few months after he testified in support of a Senate bill to
appropriate $100 million to bring together the world's
outstanding cancer experts in order to coordinate a search for the
prevention and cure of cancer. At hearings before Senator Claude
Pepper's sub-committee in July 1946, Gerson demonstrated
recovered patients who had come to him after conventional
methods could no longer help. Dr. George Miley, medical director
of the 85-bed Gotham Hospital, where Gerson had treated
patients since January, 1946, gave strong supporting medical
testimony (U.S. Congress, 1946).
In a surly editorial response, JAMA said it was "fortunate" that
this Senate appearance received little newspaper publicity; the
AMA was clearly outraged that Gerson's appearance had become
the subject of a favorable radio commentary, broadcast
nationwide by ABC's Raymond Gram Swing (U.S. Congress, 1946,
31-35; JAMA, 1946). The JAMA editorial focused on Gerson, even
though it was not Gerson but a lay witness, immune to AMA
retaliation, who had called Gerson's successes "miracles" and
urged the Senators to secure their future cancer commission
38
against control by any existing medical organization (U.S.
Congress, 1946, 96,97).
It was not Gerson, but Dr. Miley, who told the Senators that a
long-term survey by a well-known and respected physician
showed that those who received no cancer treatment lived longer
than those who received surgery, radiation or X-ray (U.S.
Congress, 1946, 117). Perhaps because Miley was a Northwestern
medical graduate, an established physician licensed in four
states, and a fellow of the AMA and state and county societies of
Pennsylvania and New York, Morris Fishbein did not attack him
personally. Instead, he limited himself to intimations of fiscal
impropriety in the Robinson Foundation, which owned Miley's
Gotham Hospital, and to the scandalous revelation that the
director of the section on health education of this Foundation
(which was promoting "an unestablished, somewhat questionable
method of treating cancer") was not an M.D. at all, but a Yale
University professor of economics!
Compared to Miley's testimony, Gerson's was innocent,
concentrating on the histories of the patients he brought with him
and on the likely mechanisms whereby his diet caused tumor
regression and healing. Only under pressure from Senator Pepper
did Gerson state that about 30% of those he treated showed a
favorable response ( U.S. Congress, 1946, 115). Nonetheless,
JAMA devoted two pages to undermining Gerson's integrity
(JAMA, 1946). Showing no restraint where Gerson was concerned,
Fishbein, contrary to fact, alleged that successes with the Gerson-
Sauerbruch-Hermannsdorfer diet "were apparently not
susceptible of duplication by most other observers. " He also
falsely claimed that Gerson had several times refused to supply
the AMA with details of the diet. (Fishbein said he could provide
them in this editorial only because "there has come to hand
through a prospective patient" of Gerson a diet schedule for his
treatment.) Fishbein emphasized, without comment, Gerson's
caution about the use of other medications, especially
39
anesthetics, because they produced dangerously strong reactions
in the heightened allergic state of his most responsive patients.
Fishbein attempted to tie together this strange patchwork of slurs
against Gerson and against research supported by lay-dominated
industrial corporations with his accustomed mastery of innuendo:
"The entire performance, including the financial backing, the
promotion and the scientific reports, has a peculiar effluvium
which, to say the least, is distasteful and, at its worst, creates
doubt and suspicion" (JAMA, 1946, 646).
Through no fault of his own, Gerson was again portrayed
favorably in the news in 1947, when John Gunther, in Death Be
Not Proud, credited Gerson with extending the life of Gunther's
son during the boy's ultimately unsuccessful struggle with brain
cancer. Beginning that same year the New York County Medical
Society staged five "investigations" of Gerson and eventually
suspended him for "advertising" his "secret" methods.
At this point Gerson's life took on a nightmare quality. The
Pepper-Neely bill met defeat and, with it, the hope for coordinated
cancer research free of prior restraints against investigations of
anything other than "established" methods. In 1949 the AMA
Council on Pharmacy and Chemistry, in a report entitled "Cancer
and the Need for Facts", rehashed material from the earlier
editorial, adding that the Gerson diet was "lacking in essential
protein and fat" and that Gerson's concern about the dangers of
anesthesia was "wholly unfounded and apparently designed to
appeal to the cancer victim already fearful of a surgical operation
which might offer the only effective means for eradication of the
disease". Without benefit of either a literature search or new
clinical or laboratory research, the Council labeled as a "false
notion" the idea that "diet has any specific influence on the origin
or progress of cancer". They concluded that "There is no scientific
evidence whatsoever to indicate that modifications in the dietary
intake of food or other nutritional essentials are of any specific
value in the control of cancer" (Council on Pharmacy and
Chemistry, 1949, 96). Gerson lost his hospital affiliation and
40
found that young doctors who wanted to assist him and learn
from him could not do so, for fear of incurring Society discipline.
He was denied malpractice insurance, because his therapy was
not "accepted practice" (Moss, 1980, 178; Natenberg, 1959, 136).
In the early fifties Gerson submitted five case histories to the NCI,
requesting an official investigation. He was told that they would
need 25 cases, which he promptly supplied, with full
documentation. More than a year later the NCI demanded 125
case histories, saying that the 25 they had previously requested
were insufficient to justify investigation.
According to a 1981 publication of the Gerson Institute, headed
by his daughter, Charlotte Gerson, a manuscript for a book he
was writing about his therapy disappeared from his files in 1956
(Healing, 1981, 19) At the age of 75, isolated from medical
colleagues and unable to find assistants, Gerson undertook the
work of rewriting the entire manuscript in order to show "that
there is an effective treatment of cancer, even in advanced cases"
(Gerson, 1958, 3). It was published in 1958, as A Cancer
Therapy: Results of Fifty Cases. Gerson died of pneumonia the
following year, before finishing a second volume. His ideas have
gained wide distribution through subsequent editions of his book
(1975, 1977, and 1986); through a 1962 publication called Has
Dr. Max Gerson a True Cancer Cure?, which had reportedly sold
more than 250,000 copies by 1980 (Moss, 1980, 178); and
through the publications and physician-training programs of the
Gerson Institute in Bonita, California, and the Hospital de Baja
California.
In 1980 a reformed JAMA carried a commentary called "The
'Grand Conspiracy' Against the Cancer Cure" by William Regelson
of the Department of Medicine of the Medical College of Virginia.
Surveying a series of "inappropriate judgments [that] have
resulted in injury to good observations," Regelson said, "We may
shortly have to ask if Gerson's low-sodium diet, with its bizarre
coffee enemas and thyroid supplementation, was an approach
that altered the mitotic regulating effect of intracellular sodium
41
for occasional clinical validity in those patients with the stamina
to survive it" (Regelson, 1980, 338).
Disregarding such suggestions and resting its case instead on the
claim that the NCI had "found no convincing evidence of
effectiveness" during a review of ten Gerson cases some forty
years earlier, the American Cancer Society in 1987 stated that
"The Gerson method of cancer treatment is not considered a
proven means of cancer treatment, and on the basis of available
information, the Institute does not believe that further evaluation
of this therapy is called for at this time" (American Cancer
Society, February 5, 1987).
Testing is underway, however, outside of the U.S. Since 1984 a
modified form of Gerson's therapy has been in use at the Second
Department of Surgery of the Krankenhaus in Graz, Austria.
Omitting liver juice and niacin, using thyroid only in hypothyroid
patients, and limiting caffeine enemas to two per day, Peter
Lechner and his colleagues, all of them surgeons, have been
testing the Gerson method as an adjunct, often with
chemotherapy or radiation, in 60 post-operative cancer patients,
male and female, ranging in age from 23 to 74, and representing
many different forms of cancer. By pairing each patient who was
willing to use the Gerson method (GP) with one of similar age and
condition who chose not to try it (NGP) and observing the
comparative progress of the disease in the two groups over a four-
year period, Lechner and his colleagues have approximated a
controlled study of admittedly imperfect structure (Lechner, 198
7).
Their findings show that the Gerson therapy made a notable
difference in several forms of cancer. Although GPs with bone
metastases had no better survival or tumor response than NGPs,
their relief from pain and absence of hypercalcemia made for a
better quality of life. GPs with lung metastases required fewer
procedures to relieve pleural effusion. GPs with brain metastases
experienced decreased edema and lived four months longer than
their paired NGPs. Premenopausal and perimenopausal breast
42
cancer GPs tolerated conventional treatments better, with fewer
side effects; showed better liver and kidney function and blood
counts; and had fewer local recurrences and no metastases.
Breast cancer GPs with liver metastases tolerated chemotherapy
better, and one of three has been in a steady state for more than
a year, while the remaining five have died. GPs with colorectal
carcinoma seemed to gain weight and recover better after surgery,
but showed no significant difference in incidence of secondaries
or local recurrence. The best responders to date are GPs with liver
metastases, with two GPs showing improved hepatic enzyme
profiles compared to two NGPs; in four other pairs, although
profiles remained similar, the GPs lived twice as long as the NGPs
(Lechner, 1987).
It is an irony of both history and geography that the first
comparative study of Max Gerson's therapy should take place at
the hands of surgeons, in that part of the world which Gerson fled
as a Jewish refugee half a century ago and that the results, while
not so outstanding as those he seemed able to produce, are most
encouraging in patients with severe damage to the liver, the organ
he considered central to recovery.
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Recommended